Across the Gulf Cooperation Council (GCC), healthcare systems are at an inflection point. Most GCC governments have made clear commitments to improving population outcomes, controlling longterm costs, and building sustainable health systems that can support economic transformation agendas.  

This is driven by the harsh realities that are today being felt in escalating medical inflation, but also because private funders (mostly employers) and public funders (governments) are seeing what future funding challenges will occur as populations age and the impacts of high chronic disease fuels healthcare consumption. 

ValueBased Healthcare (VBHC) has emerged as a unifying ambition across the region, embedded within national strategies in Saudi Arabia, the UAE, Oman, Qatar, and beyond. Yet while the desire and intention to adopt VBHC, practical implementation examples that are driving material impact remains scarce. 

Emica has been working over the last few years with regulators, providers and payors helping them  consider and then operationalize VBHC.  From our perspective, shaped by handson work with health system leaders across the GCC, the gap between intention and action is not driven by a lack of understanding or even because of intitutional inertia. It is driven by first move executional choices. We see the difference between VBHC initiatives that scale and those that stall lies in how well they are planned and how well they are grounded in regional realities. 

A recurring challenge in the GCC is the tendency to import VBHC models developed in North America or Europe with limited adaptation (risk adjusted capitation as an example). While these models offer valuable reference points, GCC health systems operate under fundamentally different conditions. Public financing plays a dominant role, governments act as both funder and steward, and service delivery is split across of dominant public that co-exist with rapidly expanding private sectors. Population health needs are shaped by high prevalence of chronic disease, younger demographic profiles, and fastgrowing demand for tertiary care. In this context, VBHC cannot be implemented as a single structural leap from feeforservice to full risk transfer. 

Successful programs begin by truly acknowledging where the system is today rather than just theorizing where it aspires to be. In Emica’s experience supporting valuebased reimbursement and payforquality programs for large GCC insurers and health systems, progress is achieved through pragmatic sequencing. Incremental mechanisms that sit on top of existing payment models allow stakeholders to build confidence, capability, and trust before moving toward more advanced forms of risk sharing. Ambition remains essential, but it must be matched with realism. 

We have seen that the point at which many VBHC strategies falter is at contracting. Policy frameworks often articulate highlevel outcome goals, but these ambitions frequently fail to translate into contract terms that payers and providers want to and practically can operationalise. For valuebased healthcare to change behaviour, outcomes must be clearly defined, measurable using available data, and directly linked to financial consequences. Without this, VBHC risks becoming a reporting exercise rather than a lever for transformation and unfortunately payors in the end just use the exercise to reduce costs rather than incentivise the right provider behaviors. 

Emica has seen VBHC gain traction when payers focus on what can genuinely be contracted for. This involves selecting outcome and quality measures (CROMs, PROMs & PREMS) that are clinically meaningful but also feasible to measure at scale, aligning incentive structures with material financial impact, and ensuring that providers understand how performance translates into payment. Transparency is critical. When scoring methodologies and benchmarks are clearly articulated, VBHC shifts from being perceived as a compliance burden to a shared performance framework. 

Provider engagement remains one of the most sensitive aspects of VBHC implementation across the GCC. Resistance is often framed as cultural, but in reality it is frequently a rational response to misaligned expectations. Many providers operate in highcost environments, face workforce constraints, and have limited control over patient behaviour or referral flows. When asked to assume risk without access to timely data or without influence over the full care pathway, hesitation is inevitable. 

Programs that succeed take a different approach. They recognise that trust must precede risk transfer. Early phases focus on upsideonly incentives, peer benchmarking rather than punitive thresholds, and regular performance feedback that providers can act on. Over time, as confidence grows and operational issues are resolved, more advanced risksharing arrangements become possible. In the GCC context, VBHC is as much a changemanagement journey as it is a technical reform. 

Globally data is often cited as both the greatest enabler and the greatest barrier to valuebased healthcare. This is where the GCC has an inherent advantage as it is not short of healthcare data, particularly claims data (e.g. via NPHIES in KSA), but it frequently lacks data that is structured, standardised, and trusted enough to support decisionmaking. Too many VBHC initiatives invest heavily in dashboards while underinvesting in data governance, metric definition, and attribution logic. 

Emica’s experience designing provider quality frameworks and performance dashboards across the GCC suggests that impact comes not from complexity but from clarity. A smaller set of welldefined metrics, aligned across stakeholders and embedded into contracting and performance discussions, delivers far more value than expansive indicator libraries that are rarely used. Data should exist to inform decisions and conversations, not simply to demonstrate analytical sophistication. 

Another consistent lesson we see is the importance of focus. Attempting to implement VBHC across the entire system simultaneously we have not yet seen to be successful. Programs that gain momentum typically start with care pathways where value is visible, variation is well understood, and outcomes can be meaningfully measured. Highvolume specialties, defined episodes of care, and chronic conditions with established guidelines offer natural entry points. Early success in these areas creates proof points that build confidence and support broader system adoption. 

Ultimately, valuebased healthcare in the GCC must be treated not as a timebound reform project but as a longterm capability build. Health systems that make sustained progress invest in internal contracting expertise, clinical quality leadership, and provider engagement capacity. They align VBHC explicitly with national transformation agendas rather than treating it as a standalone initiative. Most importantly, they accept that early programs are learning mechanisms, designed to evolve rather than to deliver perfection from day one. 

From Emica’s perspective, the real accelerator of valuebased healthcare in the GCC is pragmatism & focus. The region has ambition, funding, and political commitment in abundance. What determines success is disciplined execution grounded in local context. VBHC delivers impact when it is contractible, measurable, operationally realistic, trusted by providers, and aligned to national priorities. Bridging the gap between intent and impact is not about copying global models, but about building valuebased systems that reflect how healthcare actually works in the Gulf today.